Treatments For Fungus Toenails

One of the most common complaints seen in any podiatrist's office is the problem of fungus toenails or onychomycosis.  This is also one of the most frustrating conditions for not only the patient, but for the treating doctor also.  Success in treating onychomycosis has been elusive. Even with successful treatment, re-infection is common.

          

Unlike skin fungus, fungus of the nails is deep within the toenail, and thus it is difficult for a topical medication to reach it.  Most of the older topical medications and over the counter medications have been proven to be ineffective.  Home remedies are widely used, but I have not seen much improvement with them in my practice.  Newer prescription topical medications such as Kerydin and Jublia are much more effective in treating onychomycosis.  These medications must be applied to each affected toenail daily for at least 9-10 months.

          

The most effective way of curing onychomycosis is with oral medication.  Lamisil has been used for many years and is still considered the gold standard.  The concern with Lamisil therapy is that, in a small percentage of people, the liver enzymes can be affected.  It is for this reason that blood tests are required both before and during the three month course of treatment.

          

There is a new drug for onychomycosis currently awaiting final approval by the FDA.  This drug is called Viamet.  The exciting aspect of this drug is that it does not affect the liver.

           

With new medications on the horizon, the prospect of getting rid of toenail fungus has never been better.

          

If fungus toenails are a concern, please call us so we can explore the possibilities of an effective treatment.

Evan Kelner DPM

 Ingrown Toenails

One of the most common conditions seen in a podiatrist's office is the ingrown toenail.  An ingrown toenail is a condition in which a side of the toenail grows into the flesh.  This can be a painful condition, both with and without pressure to the area.  If ignored, the toenail border can penetrate the skin, causing a bacterial infection.

           

Ingrown toenails are mostly a hereditary condition.  The toenail generally follows the shape of the bone beneath it.  Ingrown toenails can also be caused by improper cutting of the toenails. The condition may be exacerbated by wearing tight shoes.

            

Soaking the area, followed by dressing changes, may temporarily slow the progression, but ultimately, the ingrown portion of the toenail must be cut out.  This should be done by a podiatrist. If there is an infection, local anesthesia may be needed.

            

If the problem becomes recurrent, a permanent removal of the ingrown part of the toenail can be achieved by a simple office procedure.  A chemical is used to destroy the cells that make only that part of the toenail grow.  No sutures are needed.  Normal skin soon fills the area and there is an acceptable cosmetic result.

                                     

                                Some Tips for Preventing Ingrown Toenails:

1) Always cut toenails straight across or along the contour of the toenail

2) Do not dig into the ingrown toenail or perform "bathroom surgery"

3) Avoid tight restrictive footwear.

If you have an ingrown toenail, seek attention as soon as you can.  They tend to get worse as time goes by!

Evan Kelner DPM

 Advanced Treatments in Wound Healing

 As our population ages, the prevalence of diabetes in on the increase.  One of the most worrisome consequences of diabetes is the formation of diabetic ulcers.  Many of us know someone who's life has been drastically changed by diabetic ulcers.

There are several reasons these ulcers develop, and that is why these wounds are so difficult to heal.  There are wound centers all over the country whose sole mission is to treat these dangerous wounds.

                          

Over the years, many wound care treatments have come in and out of favor.  The newer treatments now focus at the cellular level.  Wound care products now include components of human umbilical cord, amnionic membrane, extracellular matrix, human growth factors and purified collagen matrix, just to name a few.  These newer treatment have saved many limbs and have prolonged lives.

                         

Of course, the best way to combat diabetic ulcers is to prevent them.  Because of advanced treatments with a multi-disciplined team approach, treatments for diabetic and other wounds have never been better, and continue to improve.  If you are diabetic, and have not had a medical professional check your feet, do so soon.  If you believe you are developing a foot wound, see a podiatrist without delay.

Evan Kelner DPM

Preventing Diabetic Foot Ulcers

       -abbreviated from article by Jarrod Shapiro, DPM in Podiatry Management, March 2016

     For people with diabetes, one of the scariest risks they face is the prospect of foot ulcers and subsequent amputation.  The statistics are disturbing:

        - Between 15-25%of diabetics will develop a foot ulcer at some time.

        - 2-6% will develop a wound yearly.

        - 84% of non-traumatic limb amputations in diabetes are preceded by an ulcer.

        - 34% of patients develop a new ulcer within one year of healing their first ulcer.

        - There is a 50% risk of developing a foot ulcer on the opposite limb after major limb                               amputation, and a 50% risk of amputation of that limb within 2-5 years.

        - The survival rate after a major limb amputation is 50% after 3 years, and 40% after   

                     5 years.

    These odd are truly sobering.

    If you are diabetic, and you get an foot ulcer, you are highly likely to have a future one.  If you ulcerate, you're much more likely to have a limb amputation.  If that occurs, your life expectancy is much lower.

    The good news is most of the ulcers can be prevented.

    Naturally, education of the diabetic patient is the first step.  Knowing how to prevent problems enables you to reduce the risk.  A podiatrist can educate you on proper foot care.  But that is not enough.

    Studies have found that prescription therapeutic shoes do, indeed, prevent foot ulcers, compared with non-prescription shoes.  The patients, of course, need to wear these shoes for most steps during the day.

    Regular visits to the podiatrist for routine foot care is a critical action needed to prevent diabetic ulcer.  Aside from debriding thick fungal toenails and callouses, a podiatrist will examine the feet and detect signs of impending problems.

    The old saying, "an ounce of prevention is worth a pound of cure", is more than appropriate in preventing diabetic ulcers.  It may save your life.

    If you are diabetic, feel free to call our office for an appointment to have your feet checked.

732-988-0070

Best Shoes for Seniors

This is an often asked question in my office, and I'm sure in many other podiatrists' offices, as well.  The answer may not be simple, for everyone's feet are different, but there are some useful guidelines.

For many baby boomers, walking may be the only form of exercise they do. Several studies have shown the relationship between regular exercise and longer life expectancy and better health.  That is one reason why finding the right type of shoe is critical for keeping pain-free, active and healthy.

Common foot problems unique to seniors are fat atrophy, arthritis, neuropathy and muscle weakness.  In general, a supportive shoe with a soft innersole or memory type insert is a good start.  Along with muscle strengthening and stretching exercises, lighter shoes can be worn with greater success.

Running shoes for seniors are a good choice since they are lightweight, more "breathable", and have better cushioning and support than conventional slip-on shoes.  Seniors should avoid heavy or bulky shoes, as they can cause tripping, falling or just inactivity.  If the shoes have no stability or support, in the case of slippers or moccasins, patients can loose balance, fall or develop foot or arch pain.  For patients who use walkers or canes, Velcro or Lycra style shoes are usually well tolerated.

Always be certain to buy shoes that are roomy in the toe-box, well cushioned, have a slightly raised heel and an sole that neither "slips" or "grips".  When trying on shoes, they should feel comfortable immediately.  There is no such a thing as "breaking in" shoes.

                       

Our office is always happy to assist in evaluating your foot care needs and keeping you as healthy as possible in 2017!

Springing into Running? Avoid the Injuries

The following article was recently written by Dr. Dennis Cardone

                

While running offers many health benefits, it is also associated with high risk of injury. Approximately 40 to 60 percent of runners have at least one significant injury each year. There are multiple factors involved in running injuries, but most are caused by errors in training or over training.

Some common training errors are high intensity running without rest days, sudden increases in mileage or intensity, or a single strenuous or long training session or competition.

                        

Two very common running injuries are iliotibial band syndrome and medial tibial stress syndrome ( commonly known as "shin splints" ). Iliotibial band syndrome is an overuse-type injury that causes sharp pain on the outside part of the knee. when running.  The pain usually comes on at a constant point or distance during each work out. Factors that can lead to the developement of iliotibial band syndrome are training errors, excessive hills or running on a banked surface.

                        

The treatment of iliotibial band syndrome includes a combination of reduced running, stretching and strengthening of the abductor muscles, orthotics when biomechanical problems exist, and injection therapy for resistant cases.

                        

Medial tibial stress syndrome causes pain along the inside part of shin. Symptoms are initially brought on only with running but as the condition worsens symtoms may appear even with walking.  Sudden increases in mileage or intensity is a leading cause of medial tibial stress syndrome. Other contributing factors are poor running mechanics and muscle tightness.

                         

The treatment of media tibial stress syndrome varies according to the intensity of symptoms. Most runners need to stop running for a period of time until symptoms resolve.

                        

Low impact activities such as cycling or swimming may be substituted. Specific stretching and strengthening exercises are also part of the treatment plan.

                                                         

Some general guidelines to avoid running injuries are;

1) Gradually increase the distance or intensity of runs (increase mileage by no more than 10 percent per week).

2) Higher mileage correlates with increased frequency of injuries.

3) Don't run 7 days a week.  Add rest days or run only every other day. On off days it's okay to substitute cycling or swimming.

4) Cross-train (low-impact activities) regularly to give your body a rest.

5) Softer running shoes are better.

6) Listen to your body. Don't run through pain.

7) Use proper running shoes and change them at regular intervals (approximately every 400 miles or every 6 months).

8) Excessive hill work and intervals can also be injury-provoking.

Tenex Health TX

There is now exciting news for those who suffer from chronic heel pain.  In the past, for those sufferers of heel pain that did not respond to injections, medications, orthotics or physical therapy, surgical procedures would be indicated.
                 
Now there is a new advanced treatment that quickly and safely removes the source of pain.  Tenex Health TX, in conjunction with the Mayo clinic, has developed a minimally invasive treatment that has proven to be extremely effective in treating chronic heel pain.
                 
Tenex Health TX is performed with local anesthesia in a hospital setting.  During treatment, sophisticated ultrasound imaging is used to identify the location of the damaged soft tissue.  Once located, a small Microtip is inserted into the chronically damaged area through a small incision.  Ultrasonic energy then breaks down and removes damaged tissue quickly and safely, sparing surrounding healthy tissue.  Recovery is rapid, and the patient is able to walk immediately.  Relief of the symptoms normally takes about 6 weeks.
                 
If you are suffering from heel pain that has not responded to traditional conservative treatment, but do not want the risks and recovery of open surgery, Tenex Health TX may be right for you.